Title

Effect of pelvic floor muscle training among pregnant black African population on the risk of postpartum urinary incontinence, a single blind randomized control trial

Date of Award

7-1-2015

Document Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor

Prof. Zulfiqarali Premji

Second Supervisor/Advisor

Dr. Evan Sequeira

Third Supervisor/Advisor

Dr. Johnstone Miheso

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Trial registration: The study was registered at the Pan African Clinical Trial Registry and a unique identification number issued PACTR201407000850309.

Background: Pelvic Floor Muscle Training (PFMT) in the antenatal period has been found to be an effective primary prevention intervention in the Caucasian population in reducing the risk of postpartum Urinary incontinence.

Objective: This study was primarily designed to determine the effect of PFMT introduced in the second trimester amongst pregnant black African population on the risk of six weeks postpartum Urinary Incontinence.

Secondary objectives included investigating the risk of postpartum Urinary

Incontinence, the effect of mode of delivery on the risk of six weeks postpartum Urinary Incontinence and determining contributory factors in this population on the risk of postpartum Urinary Incontinence.

Study design: The study was a single blind Randomized Control Trial.

Intervention: PFMT was conducted by a Physiotherapist and a Continence Nurse from recruitment to 37 completed weeks of gestation, with the control group receiving standard Antenatal care.

Assessment of urinary incontinence status: Data collection was done primarily by administering a validated questionnaire (ICIQ-UI Short Form) at recruitment in the Antenatal clinic and in the postpartum period at the six week postnatal visit.

Main findings: Intention to treat analysis was undertaken using the SPSS Statistics 17.0 software package. The primary outcome of the study was an estimate of the risk of 6 week postpartum Urinary Incontinence as a proportion for the treatment and control groups. The risk in the treatment group was found to be 6% while in the control group was 36%. The Risk Ratio was found to be 0.17 (95% Confidence Interval; 0.04, 0.69) and the Relative Risk Reduction was found to be 83%. Comparison of proportions was done using the Chi-square test to compare the two groups for any statistically significant difference. Χ2 (1) = 9.07, P= 0.003 which was considered statistically significant. The null hypothesis was rejected.

There was a statistically and clinically significant difference in the risk of postpartum Urinary Incontinence between PFM trained pregnant black African population and those given standard Antenatal Care.

This document is available in the relevant AKU library

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